The proposals require smokers to have given up for at least eight weeks.
Photograph: Jonathan Brady/PA

Smokers in Hertfordshire are to be breathalysed to ensure they have kicked the habit before they are referred for non-urgent surgery.

The measures have been brought in by East and North Hertfordshire clinical commissioning group (CCG) and Hertfordshire Valleys CCG, which together are attempting to save £68m.

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They said the changes were being brought in after 85% of people who responded to a public consultation agreed that smokers should be required to quit before being referred.

The proposals, revealed by the Health Service Journal, require smokers to have given up for at least eight weeks. They will have to prove this by undergoing a breath test, which will check for levels of carbon monoxide.

The CCGs also require obese patients to reduce their weight by 10% over nine months or reduce their BMI (body mass index) to less than 30, whichever is greater, before being referred for non-urgent surgery.

Ian Eardley, the senior vice-president at the RCS, condemned the policy as “discriminatory” and short-sighted.

“Singling out patients in this way goes against the principles of the NHS,” he said. “While it is right that patients are supported to lose weight or stop smoking, this should not be a condition of them receiving surgery. This goes against clinical guidance and leaves patients waiting long periods of time in pain and discomfort. It can even lead to worse outcomes following surgery in some cases.”

He said that by introducing “increasingly harsher policies” CCGs might believe they were alleviating financial pressure but they could actually cost more in the long term because of the risk of complications and the cost of healthcare in the interim.

The CCGs said no financial savings were expected as a result of the measures, which they claimed were aimed at improving the long-term health of residents. They also stressed that if at any time the harm of waiting for surgery outweighed the benefit of losing weight or stopping smoking, then the patient would be referred.

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Dr Hari Pathmanathan, a Hertfordshire GP and chairman of East and North Hertfordshire CCG, said: “These decisions haven’t been taken lightly and our conversations with the public have demonstrated that many people understand the challenges faced by the NHS in Hertfordshire and beyond.

“We understand that some of our patients will have to make changes and they will be supported to do so, for example with the free weight-loss and stop-smoking advice sessions already on offer.”

The CCGs also announced that gluten-free food, female sterilisation, IVF and other specialist fertility treatments would only be funded in exceptional circumstances.

Dr Nicolas Small, the chair of Herts Valleys CCG, said: “Although we are asking people to take more responsibility for some aspects of their healthcare where possible, we won’t be withdrawing any support from people who are not able to do this.”